Bouam Samir, Girou Emmanuelle, Brun-Buisson Christian, Karadimas Harry, Lepage Eric
Département de Biostatistiques et d'Information Hospitalier, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Infect Control Hosp Epidemiol. 2003 Jan;24(1):51-5. doi: 10.1086/502115.
To examine the reliability of the data produced by an automated system for the surveillance of nosocomial infections.
A 906-bed, tertiary-care teaching hospital.
Three surveillance techniques were concurrently performed in seven high-risk units during an 11-week period: automated surveillance (AS) based on the prospective processing of computerized medical records; laboratory-based ward surveillance (LBWS) based on the retrospective verification by ward clinicians of weekly reports of positive bacteriologic results; and a reference standard (RS) consisting of the infection control team reviewing case records of patients with positive bacteriology results. Bacteremia, urinary tract infections, and catheter-related infections were recorded for all inpatients. The performances (sensitivity, specificity, and time consumption) of AS and LBWS were compared with those of RS.
Of 548 positive bacteriology samples included during the study period, 229 (42%) were classified as nosocomial infections. The overall sensitivity was 91% and 59% for AS and LBWS, respectively. The two methods had the same overall specificity value (91%). Kappa measures of agreement were 0.81 and 0.54 for AS and LBWS, respectively. AS required less time to collect data (54 seconds per week per unit) compared with LBWS (7 minutes and 43 seconds per week per unit) and RS (37 minutes and 15 seconds per week per unit).
Our results confirm that the retrospective review of charts and laboratory data by physicians lacks sensitivity for the surveillance of nosocomial infections. The intranet-based automated method developed for this purpose was more accurate and less time-consuming than the weekly, retrospective LBWS method.
检验用于监测医院感染的自动化系统所产生数据的可靠性。
一家拥有906张床位的三级护理教学医院。
在11周的时间里，同时在七个高危科室采用三种监测技术：基于计算机化病历前瞻性处理的自动化监测（AS）；基于病房临床医生对每周阳性细菌学结果报告进行回顾性核实的基于实验室的病房监测（LBWS）；以及由感染控制团队审查细菌学结果呈阳性患者的病例记录组成的参考标准（RS）。记录所有住院患者的菌血症、尿路感染和导管相关感染情况。将AS和LBWS的性能（敏感性、特异性和时间消耗）与RS的性能进行比较。
在研究期间纳入的548份阳性细菌学样本中，229份（42%）被归类为医院感染。AS和LBWS的总体敏感性分别为91%和59%。两种方法的总体特异性值相同（91%）。AS和LBWS的Kappa一致性度量分别为0.81和0.54。与LBWS（每周每科室7分43秒）和RS（每周每科室37分15秒）相比，AS收集数据所需时间更少（每周每科室54秒）。
我们的结果证实，医生对图表和实验室数据的回顾性审查在监测医院感染方面缺乏敏感性。为此开发的基于内部网的自动化方法比每周进行的回顾性LBWS方法更准确且耗时更少。
